Temporal lobe surgery for intractable epilepsy in children: What to do with the hippocampus?

Mony Benifla, Odeya Bennet-Back, Zamir Shorer, Iris Noyman, Rima Bar-Yosef, Dana Ekstein

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose Resection of the hippocampus can cause verbal memory decline, especially in the pediatric population. Thus, preservation of the hippocampus can be crucial for the quality of life of children with intractable temporal lobe epilepsy (TLE) who are candidates for epilepsy surgery. We investigated techniques that determine whether the hippocampus is part of the epileptogenic zone and the outcomes of pediatric surgery aimed to spare the hippocampus. Methods We accessed data of children with normal hippocampus on MRI, who underwent surgery for medically refractory TLE. To identify epileptogenic areas, electrocorticography was performed in patients with space occupying lesions adjacent to the hippocampus, and long term invasive monitoring in patients with nonlesional TLE. Postoperative seizure control was classified according to Engel I-IV; Class I indicates seizure-free. Results Eleven females and 11 males met study inclusion criteria; the mean age at surgery was 11.3 years. Cortical and hippocampal electrocorticography was performed in 15 patients and long term invasive hippocampal monitoring in seven. The hippocampus was preserved in 16 patients (73%) while hippocampectomy was performed in 6 (27%). At the end of a mean follow-up of 3.5 years, 94% (15/16) of the patients who did not undergo hippocampectomy were classified as Engel I, compared to 50% (3/6) who underwent hippocampectomy. Conclusion Sparing the hippocampus in temporal lobe epilepsy surgery is possible with excellent seizure outcome, while using the proper intraoperative technique.

Original languageEnglish
Pages (from-to)81-88
Number of pages8
JournalSeizure
Volume52
DOIs
StatePublished - 1 Nov 2017
Externally publishedYes

Keywords

  • Electrocorticography
  • Hippocampus
  • Invasive monitoring
  • Pediatric neurosurgery
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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